Article (Scientific journals)
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: A patient-level meta-analysis of randomized trials
Wirz, Y.; Meier, M. A.; Bouadma, L. et al.
2018In Critical Care, 22 (1), p. 191
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Keywords :
Antibiotic stewardship; Meta-analysis; Procalcitonin; Sepsis
Abstract :
[en] Background: The clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection. Methods: For this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only. We used individual patient data from 11 trials that randomly assigned patients to receive antibiotics based on procalcitonin levels (the "procalcitonin-guided" group) or the current standard of care (the "controls"). The primary endpoint was mortality within 30 days. Secondary endpoints were duration of antibiotic treatment and length of stay. Results: Mortality in the 2252 procalcitonin-guided patients was significantly lower compared with the 2230 control group patients (21.1% vs 23.7%; adjusted odds ratio 0.89, 95% confidence interval (CI) 0.8 to 0.99; p = 0.03). These effects on mortality persisted in a subgroup of patients meeting the sepsis 3 definition and based on the severity of sepsis (assessed on the basis of the Sequential Organ Failure Assessment (SOFA) score, occurrence of septic shock or renal failure, and need for vasopressor or ventilatory support) and on the type of infection (respiratory, urinary tract, abdominal, skin, or central nervous system), with interaction for each analysis being > 0.05. Procalcitonin guidance also facilitated earlier discontinuation of antibiotics, with a reduction in treatment duration (9.3 vs 10.4 days; adjusted coefficient -1.19 days, 95% CI -1.73 to -0.66; p < 0.001). Conclusion: Procalcitonin-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and lower antibiotic treatment duration. © 2018 The Author(s).
Disciplines :
Anesthesia & intensive care
Author, co-author :
Wirz, Y.;  Medical University Department, Kantonsspital Aarau, Tellstrasse, Aarau, Switzerland
Meier, M. A.;  Medical University Department, Kantonsspital Aarau, Tellstrasse, Aarau, Switzerland
Bouadma, L.;  Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, AP-HP, Paris, France
Luyt, C. E.;  Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, Paris, France
Wolff, M.;  Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, AP-HP, Paris, France
Chastre, J.;  Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, Paris, France
Tubach, F.;  Hôpitaux Universitaires Paris Nord Val de Seine, Département d'Epidémiologie Biostatistique et Recherche Clinique, AP-HP, Paris, France
Schroeder, S.;  Krankenhaus Dueren, Department of Anesthesiology and Intensive Care Medicine, Dueren, Germany
Nobre, V.;  Hospital das Clinicas da Universidade Federal de Minas Gerais, Department of Intensive Care, Belo Horizonte, Brazil
Annane, D.;  Hôpital Raymond Poincaré, Assistance Publique - Hôpitaux de Paris, Critical Care Department, Garches, France
Reinhart, K.;  Jena University Hospital, Department of Anesthesiology and Intensive Care Medicine, Jena, Germany
Damas, Pierre ;  Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Nijsten, M.;  University of Groningen, University Medical Centre, Groningen, Netherlands
Shajiei, A.;  University of Groningen, University Medical Centre, Groningen, Netherlands
deLange, D. W.;  University Medical Center Utrecht, Utrecht, Netherlands
Deliberato, R. O.;  Hospital Israelita Albert Einstein, Laboratory for Critical Care Research, Critical Care Unit, São Paulo, Brazil
Oliveira, C. F.;  School of Medicine, Universidade Federal de Minas Gerais, Department of Internal Medicine, Belo Horizonte, Brazil
Shehabi, Y.;  Monash Health, Critical Care and Peri-operative Medicine, Melbourne, Australia, School of Clinical Sciences, Monash University, Faculty of Medicine Nursing and Health Sciences, Melbourne, Australia
van Oers, J. A. H.;  Elisabeth Tweesteden Hospital, Tilburg, Netherlands
Beishuizen, A.;  Medisch Spectrum Twente, Enschede, Netherlands
Girbes, A. R. J.;  VU University Medical Centre, Amsterdam, Netherlands
de Jong, E.;  VU University Medical Centre, Amsterdam, Netherlands
Mueller, B.;  Medical University Department, Kantonsspital Aarau, Tellstrasse, Aarau, Switzerland, University of Basel, Faculty of Medicine, Basel, Switzerland
Schuetz, P.;  Medical University Department, Kantonsspital Aarau, Tellstrasse, Aarau, Switzerland, University of Basel, Faculty of Medicine, Basel, Switzerland
More authors (14 more) Less
Language :
English
Title :
Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: A patient-level meta-analysis of randomized trials
Publication date :
2018
Journal title :
Critical Care
ISSN :
1364-8535
eISSN :
1466-609X
Publisher :
BioMed Central Ltd.
Volume :
22
Issue :
1
Pages :
191
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 16 January 2019

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